|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 00143992801
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.63 |
| Max. Negotiated Rate |
$412.42 |
| Rate for Payer: Aetna American Axle |
$297.86
|
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$320.78
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UMR Bronson Commercial |
$201.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$1,183.63
|
|
|
Service Code
|
NDC 62135030901
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$437.94 |
| Max. Negotiated Rate |
$1,065.27 |
| Rate for Payer: Aetna American Axle |
$769.36
|
| Rate for Payer: Aetna Commercial |
$1,006.09
|
| Rate for Payer: Aetna Medicare |
$591.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$769.36
|
| Rate for Payer: BCBS Complete |
$473.45
|
| Rate for Payer: Cash Price |
$946.90
|
| Rate for Payer: Cofinity Commercial |
$1,017.92
|
| Rate for Payer: Cofinity Commercial |
$828.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$828.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.90
|
| Rate for Payer: Healthscope Commercial |
$1,065.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$828.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$887.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,006.09
|
| Rate for Payer: PHP Commercial |
$1,006.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.36
|
| Rate for Payer: Priority Health SBD |
$745.69
|
| Rate for Payer: UMR Bronson Commercial |
$437.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$887.72
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$268.85
|
|
|
Service Code
|
NDC 68084007001
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.47 |
| Max. Negotiated Rate |
$241.96 |
| Rate for Payer: Aetna American Axle |
$174.75
|
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna Medicare |
$134.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.75
|
| Rate for Payer: BCBS Complete |
$107.54
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Cofinity Commercial |
$188.20
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health SBD |
$169.38
|
| Rate for Payer: UMR Bronson Commercial |
$99.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$2.69
|
|
|
Service Code
|
NDC 68084007011
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna American Axle |
$1.75
|
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.75
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
NDC 68084007011
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Aetna American Axle |
$1.75
|
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.75
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Healthscope Commercial |
$2.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: PHP Commercial |
$2.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.02
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$268.85
|
|
|
Service Code
|
NDC 68084007001
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.29 |
| Max. Negotiated Rate |
$241.96 |
| Rate for Payer: Cofinity Commercial |
$188.20
|
| Rate for Payer: Cofinity Commercial |
$231.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$188.20
|
| Rate for Payer: Aetna American Axle |
$174.75
|
| Rate for Payer: Aetna Commercial |
$228.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.75
|
| Rate for Payer: Cash Price |
$215.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.08
|
| Rate for Payer: Healthscope Commercial |
$241.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$188.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$201.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.52
|
| Rate for Payer: PHP Commercial |
$228.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.75
|
| Rate for Payer: Priority Health SBD |
$169.38
|
| Rate for Payer: UMR Bronson Commercial |
$118.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$201.64
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$271.70
|
|
|
Service Code
|
NDC 00904724361
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna American Axle |
$176.60
|
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.60
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$190.19
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.60
|
| Rate for Payer: Priority Health SBD |
$171.17
|
| Rate for Payer: UMR Bronson Commercial |
$119.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$271.70
|
|
|
Service Code
|
NDC 00904724361
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$244.53 |
| Rate for Payer: Aetna American Axle |
$176.60
|
| Rate for Payer: Aetna Commercial |
$230.94
|
| Rate for Payer: Aetna Medicare |
$135.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.60
|
| Rate for Payer: BCBS Complete |
$108.68
|
| Rate for Payer: Cash Price |
$217.36
|
| Rate for Payer: Cofinity Commercial |
$190.19
|
| Rate for Payer: Cofinity Commercial |
$233.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$190.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.36
|
| Rate for Payer: Healthscope Commercial |
$244.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.94
|
| Rate for Payer: PHP Commercial |
$230.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.60
|
| Rate for Payer: Priority Health SBD |
$171.17
|
| Rate for Payer: UMR Bronson Commercial |
$100.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.78
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 51079018201
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 00904708361
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.07 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna American Axle |
$227.60
|
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.60
|
| Rate for Payer: Priority Health SBD |
$220.59
|
| Rate for Payer: UMR Bronson Commercial |
$154.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 00143992801
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$412.42 |
| Rate for Payer: Aetna Medicare |
$229.12
|
| Rate for Payer: Aetna American Axle |
$297.86
|
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$320.78
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.86
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UMR Bronson Commercial |
$169.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 51079018201
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health SBD |
$2.14
|
| Rate for Payer: UMR Bronson Commercial |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
OP
|
$350.15
|
|
|
Service Code
|
NDC 00904708361
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.56 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna American Axle |
$227.60
|
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna Medicare |
$175.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: BCBS Complete |
$140.06
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.60
|
| Rate for Payer: Priority Health SBD |
$220.59
|
| Rate for Payer: UMR Bronson Commercial |
$129.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
CIPROFLOXACIN 500 MG TABLET
|
Facility
|
IP
|
$1,183.63
|
|
|
Service Code
|
NDC 62135030901
|
| Hospital Charge Code |
25119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$520.80 |
| Max. Negotiated Rate |
$1,065.27 |
| Rate for Payer: Aetna American Axle |
$769.36
|
| Rate for Payer: Aetna Commercial |
$1,006.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$769.36
|
| Rate for Payer: Cash Price |
$946.90
|
| Rate for Payer: Cofinity Commercial |
$1,017.92
|
| Rate for Payer: Cofinity Commercial |
$828.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$828.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$946.90
|
| Rate for Payer: Healthscope Commercial |
$1,065.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$828.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$887.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,006.09
|
| Rate for Payer: PHP Commercial |
$1,006.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.36
|
| Rate for Payer: Priority Health SBD |
$745.69
|
| Rate for Payer: UMR Bronson Commercial |
$520.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$887.72
|
|
|
CIPROFLOXACIN 6 % (6 MG/0.1 ML) INTRATYMPANIC SUSPENSION
|
Facility
|
IP
|
$981.30
|
|
|
Service Code
|
HCPCS J7342
|
| Hospital Charge Code |
177132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$431.77 |
| Max. Negotiated Rate |
$883.17 |
| Rate for Payer: Aetna American Axle |
$637.84
|
| Rate for Payer: Aetna American Axle |
$644.28
|
| Rate for Payer: Aetna Commercial |
$834.10
|
| Rate for Payer: Aetna Commercial |
$842.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$637.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.28
|
| Rate for Payer: Cash Price |
$785.04
|
| Rate for Payer: Cash Price |
$792.96
|
| Rate for Payer: Cofinity Commercial |
$852.43
|
| Rate for Payer: Cofinity Commercial |
$693.84
|
| Rate for Payer: Cofinity Commercial |
$686.91
|
| Rate for Payer: Cofinity Commercial |
$843.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$686.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$693.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.96
|
| Rate for Payer: Healthscope Commercial |
$883.17
|
| Rate for Payer: Healthscope Commercial |
$892.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$686.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$693.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$735.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.10
|
| Rate for Payer: PHP Commercial |
$842.52
|
| Rate for Payer: PHP Commercial |
$834.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.28
|
| Rate for Payer: Priority Health SBD |
$618.22
|
| Rate for Payer: Priority Health SBD |
$624.46
|
| Rate for Payer: UMR Bronson Commercial |
$431.77
|
| Rate for Payer: UMR Bronson Commercial |
$436.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$735.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.40
|
|
|
CIPROFLOXACIN 6 % (6 MG/0.1 ML) INTRATYMPANIC SUSPENSION
|
Facility
|
OP
|
$981.30
|
|
|
Service Code
|
HCPCS J7342
|
| Hospital Charge Code |
177132
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.72 |
| Max. Negotiated Rate |
$883.17 |
| Rate for Payer: Aetna American Axle |
$637.84
|
| Rate for Payer: Aetna American Axle |
$644.28
|
| Rate for Payer: Aetna Commercial |
$842.52
|
| Rate for Payer: Aetna Commercial |
$834.10
|
| Rate for Payer: Aetna Medicare |
$490.65
|
| Rate for Payer: Aetna Medicare |
$495.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$637.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.28
|
| Rate for Payer: BCBS Complete |
$396.48
|
| Rate for Payer: BCBS Complete |
$392.52
|
| Rate for Payer: BCBS Trust/PPO |
$80.72
|
| Rate for Payer: BCBS Trust/PPO |
$80.72
|
| Rate for Payer: BCN Commercial |
$80.72
|
| Rate for Payer: BCN Commercial |
$80.72
|
| Rate for Payer: Cash Price |
$792.96
|
| Rate for Payer: Cash Price |
$792.96
|
| Rate for Payer: Cash Price |
$785.04
|
| Rate for Payer: Cash Price |
$785.04
|
| Rate for Payer: Cofinity Commercial |
$852.43
|
| Rate for Payer: Cofinity Commercial |
$686.91
|
| Rate for Payer: Cofinity Commercial |
$693.84
|
| Rate for Payer: Cofinity Commercial |
$843.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$686.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$693.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$792.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$785.04
|
| Rate for Payer: Healthscope Commercial |
$892.08
|
| Rate for Payer: Healthscope Commercial |
$883.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$693.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$686.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$743.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$735.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$834.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$842.52
|
| Rate for Payer: PHP Commercial |
$834.10
|
| Rate for Payer: PHP Commercial |
$842.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.28
|
| Rate for Payer: Priority Health SBD |
$624.46
|
| Rate for Payer: Priority Health SBD |
$618.22
|
| Rate for Payer: UMR Bronson Commercial |
$363.08
|
| Rate for Payer: UMR Bronson Commercial |
$366.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$743.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$735.98
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$141.55
|
|
|
Service Code
|
NDC 00143992950
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna American Axle |
$92.01
|
| Rate for Payer: Aetna Commercial |
$120.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.01
|
| Rate for Payer: Cash Price |
$113.24
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.24
|
| Rate for Payer: Healthscope Commercial |
$127.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.32
|
| Rate for Payer: PHP Commercial |
$120.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.01
|
| Rate for Payer: Priority Health SBD |
$89.18
|
| Rate for Payer: UMR Bronson Commercial |
$62.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.16
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
OP
|
$184.78
|
|
|
Service Code
|
NDC 65862007850
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$166.30 |
| Rate for Payer: Aetna American Axle |
$120.11
|
| Rate for Payer: Aetna Commercial |
$157.06
|
| Rate for Payer: Aetna Medicare |
$92.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.11
|
| Rate for Payer: BCBS Complete |
$73.91
|
| Rate for Payer: Cash Price |
$147.82
|
| Rate for Payer: Cofinity Commercial |
$129.35
|
| Rate for Payer: Cofinity Commercial |
$158.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.82
|
| Rate for Payer: Healthscope Commercial |
$166.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.06
|
| Rate for Payer: PHP Commercial |
$157.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.11
|
| Rate for Payer: Priority Health SBD |
$116.41
|
| Rate for Payer: UMR Bronson Commercial |
$68.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.58
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$184.78
|
|
|
Service Code
|
NDC 65862007850
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.30 |
| Max. Negotiated Rate |
$166.30 |
| Rate for Payer: Aetna American Axle |
$120.11
|
| Rate for Payer: Aetna Commercial |
$157.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.11
|
| Rate for Payer: Cash Price |
$147.82
|
| Rate for Payer: Cofinity Commercial |
$129.35
|
| Rate for Payer: Cofinity Commercial |
$158.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.82
|
| Rate for Payer: Healthscope Commercial |
$166.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.06
|
| Rate for Payer: PHP Commercial |
$157.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.11
|
| Rate for Payer: Priority Health SBD |
$116.41
|
| Rate for Payer: UMR Bronson Commercial |
$81.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.58
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$141.55
|
|
|
Service Code
|
NDC 55111012850
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna American Axle |
$92.01
|
| Rate for Payer: Aetna Commercial |
$120.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.01
|
| Rate for Payer: Cash Price |
$113.24
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.24
|
| Rate for Payer: Healthscope Commercial |
$127.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.32
|
| Rate for Payer: PHP Commercial |
$120.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.01
|
| Rate for Payer: Priority Health SBD |
$89.18
|
| Rate for Payer: UMR Bronson Commercial |
$62.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.16
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$189.53
|
|
|
Service Code
|
NDC 59651087350
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.39 |
| Max. Negotiated Rate |
$170.58 |
| Rate for Payer: Aetna American Axle |
$123.19
|
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.19
|
| Rate for Payer: Cash Price |
$151.62
|
| Rate for Payer: Cofinity Commercial |
$132.67
|
| Rate for Payer: Cofinity Commercial |
$163.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.62
|
| Rate for Payer: Healthscope Commercial |
$170.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.10
|
| Rate for Payer: PHP Commercial |
$161.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.19
|
| Rate for Payer: Priority Health SBD |
$119.40
|
| Rate for Payer: UMR Bronson Commercial |
$83.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.15
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
IP
|
$887.82
|
|
|
Service Code
|
NDC 62135031050
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$390.64 |
| Max. Negotiated Rate |
$799.04 |
| Rate for Payer: Aetna American Axle |
$577.08
|
| Rate for Payer: Aetna Commercial |
$754.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$577.08
|
| Rate for Payer: Cash Price |
$710.26
|
| Rate for Payer: Cofinity Commercial |
$621.47
|
| Rate for Payer: Cofinity Commercial |
$763.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$621.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$710.26
|
| Rate for Payer: Healthscope Commercial |
$799.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$621.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$665.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$754.65
|
| Rate for Payer: PHP Commercial |
$754.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.08
|
| Rate for Payer: Priority Health SBD |
$559.33
|
| Rate for Payer: UMR Bronson Commercial |
$390.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$665.86
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
OP
|
$189.53
|
|
|
Service Code
|
NDC 59651087350
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.13 |
| Max. Negotiated Rate |
$170.58 |
| Rate for Payer: Aetna American Axle |
$123.19
|
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Medicare |
$94.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.19
|
| Rate for Payer: BCBS Complete |
$75.81
|
| Rate for Payer: Cash Price |
$151.62
|
| Rate for Payer: Cofinity Commercial |
$132.67
|
| Rate for Payer: Cofinity Commercial |
$163.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.62
|
| Rate for Payer: Healthscope Commercial |
$170.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$132.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.10
|
| Rate for Payer: PHP Commercial |
$161.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.19
|
| Rate for Payer: Priority Health SBD |
$119.40
|
| Rate for Payer: UMR Bronson Commercial |
$70.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.15
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
OP
|
$141.55
|
|
|
Service Code
|
NDC 55111012850
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.37 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna American Axle |
$92.01
|
| Rate for Payer: Aetna Commercial |
$120.32
|
| Rate for Payer: Aetna Medicare |
$70.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.01
|
| Rate for Payer: BCBS Complete |
$56.62
|
| Rate for Payer: Cash Price |
$113.24
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.24
|
| Rate for Payer: Healthscope Commercial |
$127.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.32
|
| Rate for Payer: PHP Commercial |
$120.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.01
|
| Rate for Payer: Priority Health SBD |
$89.18
|
| Rate for Payer: UMR Bronson Commercial |
$52.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.16
|
|
|
CIPROFLOXACIN 750 MG TABLET
|
Facility
|
OP
|
$141.55
|
|
|
Service Code
|
NDC 00143992950
|
| Hospital Charge Code |
25120
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.37 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna American Axle |
$92.01
|
| Rate for Payer: Aetna Commercial |
$120.32
|
| Rate for Payer: Aetna Medicare |
$70.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.01
|
| Rate for Payer: BCBS Complete |
$56.62
|
| Rate for Payer: Cash Price |
$113.24
|
| Rate for Payer: Cofinity Commercial |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$99.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$99.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.24
|
| Rate for Payer: Healthscope Commercial |
$127.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$99.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.32
|
| Rate for Payer: PHP Commercial |
$120.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.01
|
| Rate for Payer: Priority Health SBD |
$89.18
|
| Rate for Payer: UMR Bronson Commercial |
$52.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.16
|
|
